title: Suprahilar vascular control and stapling device transection of Glissonian pedicle in major and minor hepatectomies.
abstract: OBJECTIVE
  In this study we analyzed our experience of suprahilar-posterior intrahepatic Glissonian pedicle approach using an endo-GIA vascular stapling device for the pedicle and hepatic vein division.
  
  
  METHODS
  Sixty-eight 68 major and 102 minor liver resections were performed. The hilar extrahepatic structures remain intact, and during parenchyma dissection by CUSA, the whole right or left or the appropriate segmental pedicle was isolated intrahepatically and then transected using a stapler device.
  
  
  RESULTS
  The minor liver resections was associated with significantly shorter surgery duration (95.1 + 31.1 vs. 186.6 +/- 56.5) and transection time (35.9 +/- 14.5 vs. 65.3 +/- 17.2) than major hepatectomies (p < 0.001 for all). The mean blood loss was 255.6 + 129.9 mL in minor resection and 385.7 + 200.1 mL in major resection (p = 0.003). The mean blood transfusion requirement was 300.8 + 99.5 mL for the patients with minor hepatectomy and 450.9 + 89.6 mL for those with major liver resection (p = 0.067). There was no significant difference in morbidity and mortality between the groups (p = 0.989; p = 0.920). Major as well as minor liver resection were a superior oncologic operation with no significant difference in the 3-year overall survival rates.
  
  
  CONCLUSIONS
  Liver transection using CUSA with suprahilar endo-GIA stapling of Glisson's pedicle, as well as major hepatic veins represents an effective and safe surgical procedure.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Karamarković
authors.forename: Krstina
authors.initials: K
authors.lastname: Doklestić
authors.forename: Nada
authors.initials: N
authors.lastname: Popović
authors.forename: Pavle
authors.initials: P
authors.lastname: Gregorić
authors.forename: Sanja Tomanović
authors.initials: ST
authors.lastname: Vujadinović
authors.forename: Natasa
authors.initials: N
authors.lastname: Milić
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004867:Equipment Design; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality